Provider Demographics
NPI:1427534445
Name:CHUNDURU, SANDEEP (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:
Last Name:CHUNDURU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10928 TRINITY PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7230
Mailing Address - Country:US
Mailing Address - Phone:209-474-8000
Mailing Address - Fax:
Practice Address - Street 1:10928 TRINITY PKWY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7230
Practice Address - Country:US
Practice Address - Phone:209-474-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1222351223G0001X
CADDS1097011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice